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PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Progesterone is the naturally occurring progestogen and a subclass of the sex hormones. It is secreted by the ovary as part of the menstrual cycle. It was first isolated in 1934 by Butenandt. Progestogens are synthetic forms of progesterone.

Progestogens were developed because progesterone could not be absorbed orally, although a novel method of processing progesterone via micro-ionising is available.[1]

Suitability

They provide an alternative form of hormonal contraception for patients deemed unsuitable for the combined oral contraceptive pill (COCP). This makes it suitable for the following patients:

Methods of administration

Requires full counselling and warning regarding menstrual disturbances and delay in return to full fertility. Use beyond two years of Depo-Provera® needs to be evaluated carefully. Depo-Provera® provides contraception for twelve weeks.

Noristerat® provides contraception for eight weeks, which may be useful in certain scenarios.

Implants - Nexplanon® provides contraception for up to three years when implanted subdermally.

Progestogens should be avoided in patients with a history of liver tumours, those with genital or breast cancer (unless being used to treat these conditions), severe arterial disease, undiagnosed vaginal bleeding and acute porphyria, or if there is a history of idiopathic jaundice, severe pruritus or pemphigoid gestationis occurring during pregnancy.

Hormone replacement therapy (HRT)

Postmenopausal women who have a uterus and take oestrogens for HRT require progestogen, either on a cyclical or a continuous basis, to prevent cystic hyperplasia of the endometrium and the possible development of endometrial cancer.

Postmenopausal women have unopposed oestrogens which can lead to endometrial hyperplasia and carcinoma. Use of progestogens for twelve or more days in each cycle can reduce this risk.

Continuous progestogens have been used to prevent unwanted uterine bleeding. This usually needs to be combined with oestrogens to prevent endometrial atrophy.

Endometriosis

See also the separate article on Endometriosis. A commonly used progestogen in endometriosis is medroxyprogesterone acetate.[2]

Progestogens are thought to prevent implantation and growth of regurgitated endometrium.

Some theories suggest that progestogens have an anti-inflammatory effect on ectopic endometrium.

Progestogens have been shown in several studies to reduce pain from endometriosis, with minimal side-effects.

Progestogens have no effect on fertility rates in endometriosis.

Progestogens have been previously used in the prevention of recurrent miscarriages - this is no longer recommended.

Premenstrual syndrome

The premenstrual syndrome consists of mental and physical symptoms which are related to the menstrual cycle.

The aetiology is unclear.

Some theories suggest it is related to sex steroids, as it is not seen in anovulatory cycles.

It is thought to relate more to oestrogens.

Some investigators theorised that a lack of progestogens is the cause, leading to the use of progestogens in this condition.

There is no clear evidence to support the use of progestogens.

Anticancer hormonal therapy

Treatment is not curative but can induce remission in 15-30% of patients.[7]

Megestrol - breast cancer and endometrial cancer (advanced disease). Efficacies of progestogens are not proven and current practice is to combine progestogens with platinum or taxane chemotherapeutic agents.

Things to consider prior to starting

There is a small increase in the risk of breast cancer in women who are on or have recently used the progestogen-only contraceptive pill.

However, the progestogen-only contraceptive pill can be used in women with a previous history of breast cancer if there has been no evidence of recurrence for five years and non-hormonal contraceptive methods are unacceptable.[4]

Examine: breasts, blood pressure.

Investigations: HDL in high cardiovascular risk group.

Educate the patient to self-examine breasts.

Common side-effects

Urticaria, acne, weight gain

Fluid retention

Hypertension

Nausea, constipation

Other adverse effects

HDL cholesterol can be suppressed - this is seen more with first- and second-generation progestogens.

Hypertension.

Decreased glucose tolerance.

Depressed mood.

Cardiovascular disease - risk is higher with older forms of COCP and greater in females with concomitant risk factors.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.